The top Republican in the state House is urging Governor Beshear to opt Kentucky out of one of the costliest provisions of the federal health care law. The Supreme Court ruling upholding the Affordable Care Act gave states the legal right to refuse an expansion of Medicaid.

"Right now in Kentucky, we have just over 800,000 people on Medicaid. This additional 400,000 is about a 48% increase. It's going to be around 1.2 million of our citizens, around 29% of our total population will be Medicaid-eligible," said Hoover.

The federal government has promised to pay 100% of the increase in Medicaid payments for the first three years, but after that, 10% of the financial burden would be shifted to the states. Representative Hoover says, in that case, Kentucky would have to choose whether to make further budget cuts or raise taxes.

Governor Beshear has said he is reviewing the court’s ruling before deciding whether to expand Medicaid.

The governor also says he is readying an executive order to set up state-run health insurance exchanges, another part of the law.